Characteristics of Acute Stroke Patients Readmitted to Inpatient Rehabilitation Facilities: A Cohort Study

Abstract

Background Reducing acute care readmissions from inpatient rehabilitation facilities (IRFs) is a healthcare reform goal. Stroke patients have higher acute readmission rates and persistent impairments, warranting second IRF hospitalization consideration. Objective To provide evidence‐based information to justify IRF readmission for patients with post‐stroke impairments. Main Outcome Measure Variables that increase the likelihood of a second IRF hospitalization. Design Retrospective cohort study. Setting Seven‐center rehabilitation network. Participants Stroke patients, readmitted to acute care, who returned or did not return to an in‐network IRF between 1 October 2014‐31 December 2017(n = 380). Interventions Univariable analyses (Returned/Did Not Return to IRF) described demographics, stroke type and risk factors. Between group differences in readmission causes, motor impairments and functional independence measure (FIM) scores were examined. Return to IRF logistic regression model included variables with P < .1. Odds ratio and 95% CI were calculated; Relative risk was calculated for categorical variables. P < .05 equaled statistical significance. Results One hundred ninety‐two stroke patients returned to IRF, 188 did not. Returned to IRF patients were younger (60.6 vs. 66 years; P < .001), sustained hemorrhagic strokes (22.4 vs. 14.2%; P = .01), had lower cardiac disease prevalence (41.7 vs. 55.3%; P = .008) or non‐Medicare insurance (59.9 vs. 39.4%; P < .001). Did Not Return to IRF patients had higher admission and discharge motor and total FIM scores. Per point decrease in discharge FIM, second IRF hospitalization odds increased 4% (OR 1.04; 95% CI 1.01‐1.07; P = .02). Hemorrhagic stroke patients had 33% increased odds or a 15% higher relative risk of second IRF hospitalization than patients with ischemic stroke [OR 1.33; 95% CI 1.21‐1.47; RR 1.15; 95% CI 1.1‐1.2; P < .001]. Non‐Medicare insurance was associated with 39% increased odds or a 20% higher relative risk of second IRF hospitalization than Medicare [OR 1.39; 95% CI 1.01‐1.92; RR 1.2, 95% CI 1.006‐1.404; P = .04). Conclusions Hemorrhagic stroke, non‐Medicare insurance or lower discharge FIM score during the first IRF hospitalization predict a second IRF stay. Further work is needed to establish the validity of within IRF stay readmission measures.

Risk of Hospital Readmission among Older Patients Discharged from the Rehabilitation Unit in a Rural Community Hospital: A Retrospective Cohort Study

“…The lower readmission rate for patients admitted to rural hospitals can be partly attributed to the Japanese rehabilitation system and health insurance. The 30-and 90-day readmission rates in this study were much lower than those in previous studies [34][35][36][37], and this may be related to the duration of rehabilitation. Previous studies, which were mostly performed in the United States, reported a rehabilitation period of 20 days [34][35][36][37], which is lower than the 52 days in this study.…”

Readmission to an Acute Care Hospital During Inpatient Rehabilitation After Stroke

“…Over 13 yrs, RTAC occurred in 4.7% of the stroke patients from our IRF. This rate is lower than previously reported; however, most of the available literature used a multicenter or a national database that gathered data from multiple IRF to calculate the RTAC rate (typically ≥10%) and predictors 6,11,12 . For example, a recent study that reviewed claims of 116,073 Medicare beneficiaries after stroke calculated a rate of 11.6% 11 .…”

“…The study did not delineate the discharge destination other than return to IRF. However, the study did compare those who returned to IRF for a second admission and those who did not 12 . Patients who returned for a second IRF admission were older, more often had cardiac disease, and had worse FIM scores than those who did not return to IRF a second time 12 .…”

“…However, the study did compare those who returned to IRF for a second admission and those who did not 12 . Patients who returned for a second IRF admission were older, more often had cardiac disease, and had worse FIM scores than those who did not return to IRF a second time 12 . This suggests that those who returned to the IRF a second time had a worse medical and functional condition than those who did not.…”

“…This rate is lower than previously reported; however, most of the available literature used a multicenter or a national database that gathered data from multiple IRF to calculate the RTAC rate (typically ≥10%) and predictors. 6,11,12 For example, a recent study that reviewed claims of 116,073 Medicare beneficiaries after stroke calculated a rate of 11.6%. 11 A recent systematic literature review noted the 30-day RTAC rate ranging between 7.8% and 16%; however, the reviewed studies were not stroke specific.…”